In this rural health centre in Haryana, the staff shortage is so bad a security guard had to collect Covid samples.

PHC
The dilapidated entrance to the PHC in Solra, Haryana (Picture credit Gravit Bhirani)

Solra: Primary health centres (PHC) are considered the backbone of public healthcare in rural India and they cater to nearly 50,000 people in some places like Solra village in Haryana’s Palwal district. The problems faced by this facility are representative of many such PHCs across India, struggling with poor infrastructure and personnel issues.

When COVID-19 broke out last year, these health facilities were expected to put up a strong fight against the pandemic. But the reality is sobering –  at the PHC in Solra, there was a time when a security guard had to start collecting samples for Covid testing due to a shortage of staff.

While a PHC is supposed to be operational 24X7, this facility operates from 9 am to 4 pm only. Locals say staff is rarely available and is rude.

In the absence of adequate infrastructure and staff, people infected with COVID-19 have been forced to travel to urban centres like Palwal (a half hour’s drive) and Faridabad (an hour’s drive) for basic care.

“Since we don’t have isolation wards, people quarantine themselves in their homes only. For poor people, we had to help them by getting them to stay at other places. We received help from Asha workers also as they used to come and keep a check on various houses,” a resident of Solra, Jitendra Bhati said.

PHC WARD
The three beds in the PHC which are lying unused (Picture credit Garvit Bhirani)

Dr Lakshay Tanwar, who is posted at the PHC, said he was infected with COVID-19 when the incident with the guard took place and he has raised the issue with higher-ups. He said he had trained two multi-purpose health workers to collect samples for Covid testing, but they made the guard collect them instead.

“I took the samples for COVID-19 for 4-5 days in May as the doctor was not available at that time but I was trained for it. Villagers questioned me about this as I was supposed to do my own duty, not take samples,” said the guard, who did not wish to be named.

Vacancies and dilapidation

The PHC caters to 16 more villages around Solra. Bhati said the PHC got ambulance service a couple of weeks ago. “There are no lab technicians, pharmacists and nurses. We’re facing a problem during the Covid crisis as the lab technician who takes samples is not available,” he said.

COVID Response Watch LogoThe doctor explained the claims of not being present at the health centre, saying he sometimes gets placed at Government Hospital, Palwal, and some other centres too. Dr Tanwar admits to the shortage of staff, saying there are vacant posts, like that of a lab technician. “At this PHC, I have never seen any patient who needs an ambulance urgently. People know the situation of PHC is not really good. Sanctioned posts are there, but staff availability is an issue. So they take patients to other PHCs or hospitals,” he said.

The problem of staff shortage at the PHC has been perpetual, even though the Centre has time and again asked states to keep them adequately staffed. In reply to a question in Lok Sabha on the shortage of doctors at PHCs, especially in rural areas, Union health minister Dr Harsh Vardhan said, “State/UT governments are impressed upon from time to time to fill up the vacant posts including those of doctors.”

The PHC at Solra was built in 1972 and is dilapidated. Dr Tanwar said he has written to higher authorities multiple times, but has just got assurances of grants. “I have been in service for more than three years. There are only three beds which are not in a condition to be used as the roof is about to collapse. I will not put a patient’s life in danger until it is in a good condition. I have been to medical colleges, but I have never seen this kind of work culture,” he said.

PHC Working Hours
Visiting hours at the PHC (Picture credit Garvit Bhirani)

According to the Union Ministry of Health and Family Welfare, there should be 4-6 beds in a PHC and the boundary wall/fencing with fate should be provided. That is not the case in Solra.

No help from higher-ups

On May 18, a councillor from Solra and concerned citizens sent a letter in this regard to chief minister Manohar Lal Khattar, state health minister Anil Vij, Palwal deputy commissioner and the Palwal MLA. They highlighted the issues the PHC was facing, but there has been no solution.

“There are some services which the CMO (Chief Medical Officer) provided after we had a word with them regarding our issues. But we still don’t have the availability of many services needed for the system to work.  We would be thankful to the government if all the services are provided to us amid the coronavirus crisis,” says an elderly villager, Rajvir.

The councillor, Jaswant Singh, told 101Reporters that Palwal MLA Deepak Mangla, who belongs to the BJP, had visited the PHC recently and likened it to a “kabootar khana”, a term used to describe a dilapidated building where only pigeons live.

He said no doctors would visit the PHC earlier, but a few had started coming only now. “There are 17,000 voters in the 16 villages. There must be 40,000-50,000 people living here. It is the oldest PHC here, but has still not been upgraded to a community health centre,” he adds.

According to the Union health ministry, a PHC ought to cover a rural population of only 30,000 people in the plains areas. “I have raised this issue with the chief medical officer in zila parishad meetings, but nothing has been done. Delivery hut (a facility for deliveries) and isolation wards are still not available for patients, but we now have an oxygen cylinder,” said the councilor.

“We don’t have an ultrasound facility here. It becomes difficult for pregnant ladies to travel to cities like Palwal and Faridabad,” says Kr Birender, one of the residents of Solra village.

Singh added that nearly three years ago, Mangla had requested the CMO to get a delivery hut opened in a month, but nothing has happened. “They don’t behave properly with me, even though I am a councilor, then how will they behave with others?” said the councilor.

When 101Reporters contacted the CMO Dr Brahmdeep Singh, he told us, “It came to my notice that the post of lab technician is lying vacant there. So we have raised the demand for providing sanction for the post. Meanwhile, one technician from nearby PHC has been posted there.” He dismissed the demand to fill the vacancies by saying the person who has raised the issue related to the vacancy of nurses is someone who wants the job for himself.

Meanwhile, the councilor claimed that Covid vaccination coverage has been poor in the village. He claimed that not even 1% of people in the 18-44 age group have been vaccinated in the village against COVID-19. “People don’t even know how to register online. We need staff for that too,” he added.

Garvit Bhirani is Gurgaon-based freelance journalist and a member of 101Reporters.com, a pan-India network of grassroots reporters.


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